The most desirable; most effective; best place to be.
I have been collecting two decades of patient reported experiences and observations. And we have observed that if our frees weren’t where they should be in those ridiculous ranges (especially the free T3), any feel-goods we achieved eventually backfires. So this page gives you great information about what is optimal and what is not. ~Janie, hypothyroid patient and site creator.
So what is meant by being optimal?
When the term “optimal” is used, it specifically refers to where our free T3 and free T4 should be in order for our feel-goods to last and not backfire.
- WHEN ON A TREATMENT THAT PROVIDES BOTH T4 and T3 (a “working” NDT or synthetic T4 with synthetic T3): Gaining on nearly two decades of our observations and experiences as revealed by STTM, optimal puts the Free T3 (FT3) in the top “area” of the range (not midrange, not just above midrange), and a Free T4 (FT4) around midrange. Both.
- WHEN ON A TREATMENT WITH T3-ONLY: Again by our observations, optimal seems to be a free T3 in the top area of the range, and for some, slightly over range. Free T4 will naturally be low on T3-only, and patients have never reported a problem with that, other than you won’t be converting to T3 behind the scenes.
Why patients discovered that being optimal isn’t just about feeling good (this could apply to the majority)
We, as hypothyroid patients, learned the hard way over the years that we will start feeling good on doses that aren’t yet close enough to optimal, like a midrange free T3. Thus, many think they have arrived and stay with a non-optimal dose.
Or another way to look at it: even though an amount may make us feel good, it’s as if it’s not enough for our weekly, monthly, or yearly needs over time. So thus, there eventually comes a return of hypothyroid symptoms. As we raise a treatment with T3 in it, we are also suppressing our own natural production and release of T3 (the communication from the hypothalamus, to the pituitary, to our thyroid), even if what our thyroid made was low. So when not on enough T3 in our treatment for our needs over time, we go backwards.
So we learned we have to find the amount of T3 (revealed by the free T3 lab) that though it’s suppressing our own release, it’s also a good replacement dose for our biological or energy needs over time. That seems to be a dose that gets the free T3 in the upper area of the range. Not a specific number–just the upper area. You can work with your doctor on what we’ve observed, though.
So tell me again: why may it backfire if we aren’t optimal with our FT3 (and FT4 if it’s in our treatment, too)?
- When we are on these thyroid meds (and if we still have a thyroid), they are going to suppress whatever remaining release of thyroid hormones we still have even if that release is low. So to the degree we suppress, we need to replace in an amount that meets our daily, weekly and monthly needs. If we don’t replace enough, it eventually backfires.
- Whether with a thyroid or without one, all your organs need the right amount of T3 to function well. Without the right amount, problems can increase like depression, brain fog, concentration issues, cortisol issues, joint pain, liver stress as revealed by liver labs, heart issues, dry skin, hair loss..on and on and on.
- Certain life circumstances will need the right amount of free T3 to help you function better during stress or demands. So if we aren’t optimal, life can demand more than you may be giving yourself.
But I’ve had problems when I tried to raise and get my FT3 optimal..
Feeling hyper, irritability or impatience with others, shakiness, jittery, high heartrate, palps, anxiety, shakiness, etc. We’ve noticed that those symptoms are about having a cortisol problem which needs discovery and treatment. Cortisol problems seem to happen from being on nothing but T4, or underdosing yourself, we’ve also noticed, as well as other chronic issues. Cortisol problems ALSO cause a high free T3 and a low free T4 when you are on T4/T3 or a working NDT, called pooling.
Just never getting there, or having a rising RT3 (reverse T3) lab results, or feeling more hypo. If we are raising with inadequate iron levels or inflammation, RT3 will go up–we see that a lot. If RT3 goes up, you will feel more hypo. Additionally, If you are still using NDT’s that patients have been reporting aren’t working as well as they used to for them, patients also report problems getting out of their hypothyroid state. Read THIS as to what went wrong with some NDTs as reported by patients.
Being made to worry about the very low TSH as I try to head towards optimal.…thus I stop the raises. As much as we like having a relationship with the doctor, this is one area we strongly have noted they are wrong and backwards about. It’s natural for the TSH to go very low, and it does NOT cause bone or heart problems. They are confusing it with Graves’ disease which causes causes the latter with a low TSH. Read about the TSH issue.
If a prescription NDT seems to have changed for the worse, what should I be on to get optimal (with the right amount of iron and cortisol)?
The following represent what patients report moving to if a certain desiccated thyroid seems to have changed for the worse as compared to what it used to do for someone.
- Synthetic T4 with Synthetic T3
- T3-only, multi-dosed.
- Compounded NDT (at the time of this writing, some compounders have a source of porcine powder which still works; others are using porcine powder which has stopped working well, say patients)
- Armour NDT may still work to get get optimal (at the time of this writing). If you have problems, others are adding T3 to it to get optimal.
- Over-the-counter NDT’s (But beware…there are many instances over the years where a particular batch brought back hypo symptoms or odd labs. That’s why patients keep a supply of T3 handy)
- Other non-American made NDT brands. Australia’s compounded, for example, still seems to be giving good results.
Do I test my free’s within a few days after a raise of my thyroid meds?
If we are on both T4 and T3, we’ve both read and noted that it takes a few weeks to see the conversion results of T4 to T3. So that may mean we work with our doctor in testing after a few weeks, not after a few days. But if on nothing but T3, we can test the free T3 in about a week.
Do I test my free’s after a dose of thyroid meds?
We’ve sure learned the hard way that it’s a no!! That is because there is a slight rise of T4 after taking meds, and a definite high rise of T3 after taking T3-containing meds. We don’t want to test those temporary rises. We want to know what we are hanging onto. So we take our meds as usual one day, then test the next morning BEFORE taking our thyroid meds for the day. (If on a T3-containing treatment, best to take it twice, or three times a day, before the next day morning test)
I have an optimal Free T3 (top of range) or higher, but Free T4 is really low?
- If this is occurring when on both T4 and T3, that can be about pooling and reveals a cortisol problem. Read this.
- This can also happen if we are on a larger amount of T3 meds and a smaller amount of T4 meds. No biggie.
- If this is occurring and you are only on T3-only, that is very normal if you feel great. If you don’t feel great, it’s also about pooling.
Can I get optimal on just T4-only like Levo or Synthroid?
Hardly ever, we have experienced or observed as patients. And even when someone gets close, it’s not uncommon to still see problems, sooner or later. Sadly, there are too many life situations that can block the conversion of T4 to T3. https://stopthethyroidmadness.com/t4-only-meds-dont-work
Can I get optimal on a low dose of T3/low dose of a working NDT, with a lot of added T4.
Hardly ever, we have experienced. It’s puts us right back to depending mostly on conversion of T4 to T3.
I’m seeing my TSH go below range…
Even on non-optimal doses of a treatment with both T4 and T3, or T3-only, we have seen that it’s typical and expected to see a TSH lab result go below the range. And it will continue being low as we make our way up to an optimal dose.
Sadly, many report they’ve had to stand firm against doctors who wrongly freak out about that normal low TSH with T3 in your treatment. Our low TSH is not the same as the low TSH seen with Graves’ disease, the hyperthyroid side of the coin that doctors confuse it with. Our low TSH when optimal with the frees does NOT cause bone loss or heart disease–it’s uncontrolled Graves’ disease that can do that, or still being underdosed, or having an iron or cortisol problem keeping us underdosed.
To the contrary, when we are nearing optimal with our free T3 and free T4, or right at it, patients have reported improved bone health via scands, and improved heart health via symptoms and tests!!
Will “optimal” levels be true when I’m much older? Will it work if I have other health issues?
We’ve seen those in their 60s and 70’s report doing well with the optimal goal. But we don’t have enough feedback or experiences to know if this will be too high for everyone with an aging body. This is where if you fit this age range, it can help to find a good doctor to work with, just in case.
As far as other health issues, this is also where it’s important to work with your doctor.
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